Qualified Health Plan (QHP) requirements –
All plans must follow new coverage and benefit rules starting in 2014. The requirements are based on:
- If the plan is offered on or off the exchange.
- If the plan is fully insured or self-insured.
- The size of the Employer Group
Premiums for the individual and small group plans will not be based on health status. Instead, they will be based on family tier, age, geography and tobacco use. (State-specific rules may vary when a federally run model is not in place.) These plans also must use “3 to 1” age bands. This means the highest premium cannot be more than three times the lowest premium for the same plan. All of these requirements may have an impact on rates, although the specific effects are difficult to define at this time as qualified health plans continue to be developed.
